| Entity Name: | VILLAGE COUNSELING CENTER OF GAINESVILLE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Aug 2004 (20 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 17 Nov 2009 (15 years ago) |
| Document Number: | P04000118645 |
| FEI/EIN Number | 320128163 |
| Address: | 3919 W Newberry Road, GAINESVILLE, FL, 32607, US |
| Mail Address: | 3919 W Newberry Road, GAINESVILLE, FL, 32607, US |
| ZIP code: | 32607 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407306897 | 2016-10-10 | 2016-10-10 | 3919 W NEWBERRY RD, SUITE 5, GAINESVILLE, FL, 326074828, US | 3919 W NEWBERRY ROAD, SUITE 5, GAINESVILLE, FL, 326074848, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-373-8189 |
| Fax | 3523738190 |
Authorized person
| Name | MR. ROBERT DYLAN EDELMAN |
| Role | PRESIDENT/CEO |
| Phone | 3523738189 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH4473 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 766664100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EDELMAN ROBERT D | Agent | 3919 W Newberry Road, GAINESVILLE, FL, 32607 |
| Name | Role | Address |
|---|---|---|
| EDELMAN ROBERT D | Chief Executive Officer | 3919 W Newberry Road, Gainesville, FL, 32607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2016-02-09 | EDELMAN, ROBERT Dylan | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-25 | 3919 W Newberry Road, Suite 5, GAINESVILLE, FL 32607 | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-25 | 3919 W Newberry Road, Suite 5, GAINESVILLE, FL 32607 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-25 | 3919 W Newberry Road, Suite 5, GAINESVILLE, FL 32607 | No data |
| CANCEL ADM DISS/REV | 2009-11-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-01-26 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-02-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
